2009 English Survey

Khwisero 2009 Household Survey

1. SURVEY # _

2. G.P.S. Point #__

3. Coordinates_/_

Surveyor
4. Name

5. Date_

Household
6. Name___

7. Name of Person Surveyed

8. Gender of person surveyed (circle) Male (1) / Female (0)

9. Age ___

10a. Is the person surveyed the Household Head (Circle) Yes (1) / No (0)

10b. If no: What is relationship to Household Head (Circle)
1.Wife
2. Daughter
3.Son
4.Mother
5.Father
6.Cousin
7.Guest
8.Other___

11. Village__

12. Sub-Location_

13. Location

14. How Many Adults live in this household? __

15. How many Children?

16. Which primary school or schools do children at this compound attend?
_ _
_ _

17. What is the closest primary school to this compound?

Primary Water Collector

18. How many people collect water for this household? ___

19. Age of Primary Water Collector: ___ years old

20. Primary Occupation (circle one)
1. farming
2. business
3. student/pupil
4. housewife
5. school employee (teacher or aide)
6. other:__

21. Primary Water Collector Gender: (circle one) Male (1) / Female (0)

22a. Does the Primary Water Collector currently attend school? (circle one)
Yes (1) / No (0)

22b. If the primary water collector is a student/pupil, how much time roundtrip, during school hours is spent carrying water? (circle one)
1. Less than 30 mins
2. 30-60 minutes
3. 1.0-1.5 hours
4. 1.5-2.0 hours
5. 2.5-3.0 hours
6. 3.0-3.5 hours
7. 3.5-4.0 hours
8. 4.0 hours

22c. If the primary water collector is a student/pupil, how many trips per week are made during school hours?

23. How many years of education has the primary water collector completed: (circle one)
1. No formal education
2. Partial Primary School
3. Completed Primary School
4. Partial Secondary School
5. Completed Secondary School
6. Partial University
7. Completed University or higher education

24. How much time roundtrip does the primary water collector typically spend collecting water in the Rainy season? (circle one)
1. Less than 30 minutes
2. 30-60 minutes
3. 1.0-1.5 minutes
4. 1.5 - 2.0 hours
5. 2.0 - 2.5 hours
6. 3.0-3.5 hours
7. 3.5-4 hours
8. 4.0 hours or more

25. How many trips per week does the primary water collector make during the Rainy season? __

26. How far roundtrip does the primary water collector go to collect water during the Rainy season? (circle one)
1. 0-0.5 km
2. 0.5-1 km
3. 1.1-1.5 km
4. 1.51-2 km
5. 2.1-2.5 km
6. 2.51-3 km
7. more than 3 km

27. How much time roundtrip does the primary water collector typically spend collecting water in the Dry season? (circle one)
1. Less than 30 minutes
2. 30-60 minutes
3. 1.0-1.5 minutes
4. 1.5-2.0 hours
5. 2.0-2.5 hours
6. 2.5-3.0 hours
7. 3.5-4.0 hours
8. 4.0 hours or more

28. How many trips per week does the primary water collector make during the Dry season? __

29. How far roundtrip does the primary water collector go to collect water during the Dry season? (circle one)
1. 0-0.5 km
2. 0.5-1 km
3. 1.1-1.5 km
4. 1.51-2 km
5. 2.1-2.5 km
6. 2.51-3 km
7. more than 3 km

Water Treatment, Storage & Payment
30. Does this household collect rain water? (circle one) Yes (1) / No (0)
31. How does this Household most commonly prepare water for drinking? (circle one)
1. No preparation or treatment
2. Filter
3. Boil
4. Water Guard Treatment
5. Other __

32a. Does this household store water? (circle one) Yes (1) / No (0)

32b. Is the container used for storing water covered? (circle one) Yes (1) / No (0)

32c. How many days do you normally store water? __

33a. Does this household pay for water? (circle one) Yes (1) / No (0)

33b. How does this household pay for water? (circle one)
1.
1. per visit
2. per week
3. per month
4. per container

33c. How much do you pay for water? (based on 33b. answer) _ksh

34a. If this household does not pay for water would it be willing to if a clean source were made available? (circle one)
Yes (1) / No (0)

34b. How would you like to pay for water? (circle one)
1. per visit
2. per week
3. per month
4. per container

34c. How much would you pay for water? (based on 34b. answer) ___ksh

Water Use Habits

35. What is your primary drinking water source during the dry season? (circle one)
1. spring name:
2. borehole/dug well name:_
3. stream/pond name:_
4. rain
5. other (write in name of other) _

36. What is the most important reason why you choose this? (circle one)
1. nice
2. clean
3. good
4. availability
5. improved
6. not flooded
7. only choice
8. does not use rain water
9. near

37a. If source is chosen because it is near, how far away is the source roundtrip? (Circle one):
1. 10 mins or less
2. 11-30 mins
3. 31-50 mins
4. 30 mins - 60 mins
5. 61 mins - 1.5 hours
6. 1 hour 31 mins - 2 hours
7. over 2 hours

37b. Is this source the nearest possible source to the home during the dry season? (circle one)
Yes (1) / No (0) / Don’t know (2)

38. Are there private wells and other sources closer to the home? (circle one)
Yes (1) / No (0) / Don’t know (2)

39. What is your drinking water source during the rainy season? (circle one)
1. spring name:
2. borehole/dug well name:_
3. stream/pond name:_
4. rain
5. other (write in name of other) _

40. What is the most important reason why you choose this? (circle one)
1. nice
2. clean
3. good
4. availability
5. improved
6. not flooded
7. only choice
8. does not use rain water
9. near

41a. If source is chosen because it is near, how far away is the source roundtrip? (circle one)
1. 10 mins or less
2. 11-30 mins
3. 31-50 mins
4. 30 mins - 60 mins
5. 61 mins - 1.5 hours
6. 1 hour 31 mins - 2 hours
7. over 2 hours

41b. Is this source the nearest possible source to the home during the rainy season? (circle one)
Yes (1) / No (0) / Don’t know (2)

42. Are there private wells and other sources closer to the home? (circle one)
Yes (1) / No (0) / Don’t know (2)

Health & Attitudes Toward Water and Illness

43. Is it safe to drink water directly from the source (i.e. stream, borehole, etc.)? (circle one)
Yes (1) / No (0) / Don’t know (2)

44. Is it safe to drink water if it is clear in color? (circle one)
Yes (1) / No (0) / Don’t know (2)

45a. Are you concerned about the safety of your drinking water? (circle one)
Yes (1) / No (0) / Don’t know (2)

45b. If yes, is it because of any of the following reasons? (circle all that apply)
A. color
B. smell
C. taste
D. it makes you sick
E. other:

46. Is water that comes from a borehole or dug well cleaner than water that comes from a spring or a river?
Yes (1) / No (0) / Don’t know (2)

47. What causes diarrhea?

48. Can unclean water cause diarrhea?
Yes (1) / No (0) / Don’t know (2)

49a. In the last week, has anyone in your household had diarrhea?
Yes (1) / No (0) / Don’t know (2)

49b. If yes, for how many days? days

49c. If yes, how many members of your family were ill? people

50. When do you wash your hands? (Circle all that apply)
A. After using the bathroom
B. Before eating
C. Before cooking
D. After cleaning your child's urine
E. After cleaning your child's feces
F.Other:

51. What do you use to wash your hands? (Circle all that apply)
A. Water
B. Soap
C. Dirt
D. Ash
E. Other _

52. The water I drink can make me sick.
Yes (1) / No (0) / Don’t know (2)

53. Washing my hands can prevent illness.
Yes (1) / No (0) / Don’t know (2)

54. It is easy to wash my hands at home.
Yes (1) / No (0) / Don’t know (2)

55. It is dangerous to drink water without purification.
Yes (1) / No (0) / Don’t know (2)

56. How did you first hear about E.W.B.-M.S.U.
1. EWB Calendar
2. EWB Borehole
3. EWB Latrine
4. From children
5. From friend or relative
6. Worked on project
7.Other_
Amapesa akoburumishi khumwesi: (Total Monthly Expenses)
1. 0-1,000 ksh.
2. 1,001-5,000 ksh.
3. 5,001-10,000 ksh.
4. 10,001-20,000+ ksh.

Amapesa akawanjisinjia khumwesi: (Total Monthly Income)
1. 0-5,000 ksh.
2. 5,001-10,000 ksh.
3. 10,001-20,000 ksh.
4. 20,001-30,000+ ksh.

Omukunda kukloo kuhera kuriena? (How Much Land Do You Own) __Mutsiheka (Acres)

Nomukunda kuhera kurie okwo ulimanga? (How Much Land is Agricultural) __Mutsiheka (Acres)

Hbarera obukalukhani muliyia luno ni wina / bena? (Who has changed the community Most) (Please Circle)
1. NGO
2. Local Gov. (county council, municipal council)
3. Federal Gov. (M.P.s, abambunge)
4. Community Leaders (abemirisi bomulia)
5. Other__ (abuncli)

Mi wina owakhayanga muno khutiya ninaye? (Who would you most want to work with) (Please Circle)
1. Foreign NGO_
2. Kenyan NGO_
3. Government Agency_
4. Community Agency_
5. Other___

Moshindu shina eshiabuha eshia oluyia luno lwakhenya muno? (What is the most important community issue)